Abstract
BackgroundMeasles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi.MethodsA multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models.ResultsA total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48).ConclusionsGuardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China.Graphical abstract
Highlights
Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high
Among the primary guardians of the study participants, 58% had poor perception of susceptibility to measles, 58.6% had poor knowledge of measles severity, 35.3% had poor awareness of the benefits from measles vaccination, 41% perceived strong barriers to vaccination, 72.9% had insufficient vaccination notices, 57.6% had poor perception of self-efficacy, 51.9% had few practices towards measles vaccination, and 53.5% had a low degree of satisfaction with vaccination services provided by township hospitals
A total of 120 villages were sampled, wherein 65% did not have a village doctor involved in routine measles vaccination services
Summary
Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. While high vaccination coverage (≥ 95%) has been achieved in developed countries, the World Health Organization Europe Region (WHO/EUP) still reported large-scale outbreaks of measles in the United Kingdom, France, Spain, and Italy [5]. Most cases occurred in individuals with non-vaccination or incomplete vaccination, mainly aged ≤ 12 months or 15–29 years [6]. This implies that timely and complete measles vaccinations are critical in susceptible populations. Frequent measles outbreaks in other WHO regions with high MCV coverage rates will delay measles elimination worldwide [7, 8]
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